Marisa Elena Domino1, E Michael Foster2, Benedetto Vitiello2, Christopher J Kratochvil2, Barbara J Burns2, Susan G Silva2, Mark A Reinecke2, John S March2. 1. Drs. Domino and Foster are with the School of Public Health, University of North Carolina at Chapel Hill; Dr. Vitiello is with the National Institute of Mental Health; Dr. Kratochvil is with the University of Nebraska Medical Center; Dr. Burns is with the Duke University School of Medicine; Drs. Silva and March are with the Duke University Medical Center; and Dr. Reinecke is with Northwestern University. Electronic address: domino@unc.edu. 2. Drs. Domino and Foster are with the School of Public Health, University of North Carolina at Chapel Hill; Dr. Vitiello is with the National Institute of Mental Health; Dr. Kratochvil is with the University of Nebraska Medical Center; Dr. Burns is with the Duke University School of Medicine; Drs. Silva and March are with the Duke University Medical Center; and Dr. Reinecke is with Northwestern University.
Abstract
OBJECTIVE: The cost-effectiveness of three active interventions for major depression in adolescents was compared after 36 weeks of treatment in the Treatment of Adolescents with Depression Study. METHOD: Outpatients aged 12 to 18 years with a primary diagnosis of major depression participated in a randomized controlled trial conducted at 13 U.S. academic and community clinics from 2000 to 2004. Three hundred twenty-seven participants randomized to 1 of 3 active treatment arms, fluoxetine alone (n = 109), cognitive-behavioral therapy (n = 111) alone, or their combination (n = 107), were evaluated for a 3-month acute treatment and a 6-month continuation/maintenance treatment period. Costs of services received for the 36 weeks were estimated and examined in relation to the number of depression-free days and quality-adjusted life-years. Cost-effectiveness acceptability curves were also generated. Sensitivity analyses were conducted to assess treatment differences on the quality-adjusted life-years and cost-effectiveness measures. RESULTS:Cognitive-behavioral therapy was the most costly treatment component (mean $1,787 [in monotherapy] and $1,833 [in combination therapy], median $1,923 [for both]). Reflecting higher direct and indirect costs associated with psychiatric hospital use, the costs of services received outside Treatment of Adolescents with Depression Study in fluoxetine-treated patients (mean $5,382, median $2,341) were significantly higher than those in participants treated with cognitive-behavioral therapy (mean $3,102, median $1,373) or combination (mean $2,705, median $927). Accordingly, cost-effectiveness acceptability curves indicate that combination treatment is highly likely (>90%) to be more cost-effective than fluoxetine alone at 36 weeks. Cognitive-behavioral therapy is not likely to be more cost-effective than fluoxetine. CONCLUSIONS: These findings support the use of combination treatment in adolescents with depression over monotherapy.
RCT Entities:
OBJECTIVE: The cost-effectiveness of three active interventions for major depression in adolescents was compared after 36 weeks of treatment in the Treatment of Adolescents with Depression Study. METHOD: Outpatients aged 12 to 18 years with a primary diagnosis of major depression participated in a randomized controlled trial conducted at 13 U.S. academic and community clinics from 2000 to 2004. Three hundred twenty-seven participants randomized to 1 of 3 active treatment arms, fluoxetine alone (n = 109), cognitive-behavioral therapy (n = 111) alone, or their combination (n = 107), were evaluated for a 3-month acute treatment and a 6-month continuation/maintenance treatment period. Costs of services received for the 36 weeks were estimated and examined in relation to the number of depression-free days and quality-adjusted life-years. Cost-effectiveness acceptability curves were also generated. Sensitivity analyses were conducted to assess treatment differences on the quality-adjusted life-years and cost-effectiveness measures. RESULTS: Cognitive-behavioral therapy was the most costly treatment component (mean $1,787 [in monotherapy] and $1,833 [in combination therapy], median $1,923 [for both]). Reflecting higher direct and indirect costs associated with psychiatric hospital use, the costs of services received outside Treatment of Adolescents with Depression Study in fluoxetine-treated patients (mean $5,382, median $2,341) were significantly higher than those in participants treated with cognitive-behavioral therapy (mean $3,102, median $1,373) or combination (mean $2,705, median $927). Accordingly, cost-effectiveness acceptability curves indicate that combination treatment is highly likely (>90%) to be more cost-effective than fluoxetine alone at 36 weeks. Cognitive-behavioral therapy is not likely to be more cost-effective than fluoxetine. CONCLUSIONS: These findings support the use of combination treatment in adolescents with depression over monotherapy.
Authors: Karen T G Schwartz; Amanda A Bowling; John F Dickerson; Frances L Lynch; David A Brent; Giovanna Porta; Satish Iyengar; V Robin Weersing Journal: Adm Policy Ment Health Date: 2018-11
Authors: Zheya Jenny Yu; Christopher J Kratochvil; Ronald A Weller; Mira Mooreville; Elizabeth B Weller Journal: Curr Psychiatry Rep Date: 2010-04 Impact factor: 5.285
Authors: Timothy F Page; William E Pelham; Gregory A Fabiano; Andrew R Greiner; Elizabeth M Gnagy; Katie C Hart; Stefany Coxe; James G Waxmonsky; E Michael Foster; William E Pelham Journal: J Clin Child Adolesc Psychol Date: 2016-01-25